Patients Receive Care for Chronic Pancreatitis in a VA System with Low Diagnostic Confidence

With the exception of late-stage disease, making an accurate diagnosis of chronic pancreatitis remains a significant clinical challenge. Using established diagnostic criteria, a retrospective review from a VA cohort was performed to determine the level of confidence with which this diagnosis is applied. Evaluation for clinical factors associated with diagnostic confidence was performed.

Among 832 patient charts reviewed, 245 met inclusion criteria. Applying described diagnostic criteria, patients with a presumed diagnosis of chronic pancreatitis were evaluated for diagnostic confidence level at the time of diagnosis and again over time. Regression analysis was performed to determine clinical factors that were independently associated with a low-confidence diagnosis as well as change in diagnostic confidence over time.

57% of patients (n = 140) received a low-confidence diagnosis of chronic pancreatitis, with a more likely diagnosis identified in 67% of those cases, including underlying neoplasia (n = 12, 13%). Over 7.3 years of follow-up, 49% (n = 120) of patients maintained a low-confidence diagnosis. Alcohol use (OR 14.0; CI 1.3-111.1) and a history of acute pancreatitis (OR 12.8; CI 1.4-113.7) were associated with a change from low- to high-confidence diagnosis over time. PERT was prescribed frequently (60%, n = 148), despite low diagnostic confidence and infrequent objective testing for exocrine insufficiency (20%, n = 48).

Approximately, 50% of patients in a VA population clinically managed with a working diagnosis of chronic pancreatitis have low clinical confidence in that diagnosis. Increased diagnostic scrutiny and wider adoption of applicable diagnostic approaches are of the utmost importance.